scholarly journals BK virus nephropathy in a heart transplant recipient

2021 ◽  
Author(s):  
John Fredy Nieto-Ríos ◽  
Diego Armando Benavides-Henao ◽  
Arbey Aristizabal-Alzate ◽  
Carol Morales-Contreras ◽  
Diana Carolina Chacón-Jaimes ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Dysfunction ◽  
Heart Transplant ◽  
Immunosuppressive Treatment ◽  
Heart Transplant Recipient ◽  
Bk Virus ◽  
Transplant Recipients ◽  
Bk Virus Nephropathy ◽  
Stable Renal Function

Abstract BK virus nephropathy in kidney transplantation is widely recognized as an important cause of graft dysfunction and loss. In the case of transplants of organs other than kidney, BK virus nephropathy in native kidneys has been recognized as a cause of chronic kidney disease, which is related with immunosuppression; however, the diagnosis is usually late because the renal dysfunction is attributed to other causes, such as toxicity by anticalcineurinic drugs, interstitial nephritis due to medications, hemodynamic changes, diabetes, hypertension, etc. We report a case of BK virus nephropathy in a patient who underwent heart transplantation due to peripartum cardiomyopathy. The kidney biopsy reported active chronic tubulointerstitial nephritis associated with late stage polyomavirus nephritis and the blood viral load for BK virus was positive (logarithm 4.5). The immunosuppressive treatment was reduced, and after two years of follow-up, the patient had stable renal function with a serum creatinine of 2.5 mg/dL (GFR of 23.4 mL/min/1.73m2). We recommend that the BK virus be considered as a cause of renal dysfunction in heart transplant recipients, with the aim of detecting its replication in time to reduce immunosuppressive therapy before irreversible compromise of renal function may manifest.

scholarly journals P1762THE EFFECT OF IMMUNOSUPPRESSIVE THERAPY ON THE CLINICAL FOLLOW-UP OF BK VIRUS IN KIDNEY TRANSPLANT RECIPIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Gulay Yilmaz ◽  
Volkan Polatkan ◽  
Ebru Ozdemir ◽  
Turker Erturk ◽  
Emel Tatli ◽  
...  
Keyword(s):  
Immunosuppressive Therapy ◽  
Kidney Transplant ◽  
Antiviral Treatment ◽  
Immunosuppressive Treatment ◽  
Bk Virus ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Group I ◽  
The Mean

Abstract Background and Aims BK virus nephropathy occurs in up to 10% of kidney transplant recipients and can result in graft loss. The reactivation of BK virus is largely asymptomatic, and routine surveillance especially in the first 12-24 months after transplant is necessary for early recognition and intervention. Reduced immunosuppression and antiviral treatment in the early stages may be effective in stopping BK virus replication. This study is designed to investigate the effect of management in immunosuppressive therapy on BK virus titers and graft functions in our kidney transplant group. Method A total of 370 kidney transplant recipients between the ages of 18-69 years and receiving a triple immunosuppressive therapy (Tacrolimus+Mycophenoloic Acid+Prednisolone) were included in the study. Demographic characteristics, BK virus titers, serum creatinine and immunosuppressive drug (Tacrolimus, Everolimus) levels were measured at regular intervals in the first 24 months. Among these patients 43 of them were found to have BK virus positivity. At the time of the detection of BK virus positivity, patients were divided into three groups regarding the change in the immunosuppressive protocols: Group I: Tacrolimus + Everolimus + Prednisolone, Group II: Everolimus + Prednisolone, Group III: Tacrolimus + Prednisolone. BK virus titers and graft functions of all three groups were compared with each other. SPSS 15 for Windows was used for statistical analysis. Results The mean age of the patients was 45.3 years, and the mean duration of transplantation was 16.3 months at the time of the BK virus positivity. During the follow-up, mean Tacrolimus levels were found to be in their highest value (14.1 ng/mL) in the posttransplant three months while BK virus titer reached the highest value (1.1x106 copies/ml) in the posttransplant seven to nine months. Increased creatinine values two months after BK virus positivity were strongly correlated (p = 0.02, p = 0.008, p = 0.05, p = 0.002 at 6th, 9th, 12th and 24th months, respectively). A significant decrease in BK virus titers was observed in all three groups due to reductions in immunosuppressive treatment protocol (p = 0.005, p = 0.003, p = 0.028, in groups I, II, III respectively). Conclusion Our study favors the benefits of the prospective screening for BK virus to identify early viral replication, permit intervention, and prevent progression to nephropathy or allograft loss. The best studied treatment for BK viremia and nephropathy is careful reduction of immunosuppression

BK virus nephropathy in the native kidneys of a pediatric heart transplant recipient

2010 ◽  
Vol 14 (3) ◽  
pp. E11-E15 ◽  
Author(s):  
S. Sahney ◽  
P. Yorgin ◽  
C. Zuppan ◽  
D. Cutler ◽  
N. Kambham ◽  
...  
Keyword(s):  
Transplant Recipient ◽  
Heart Transplant ◽  
Heart Transplant Recipient ◽  
Bk Virus ◽  
Bk Virus Nephropathy ◽  
Pediatric Heart Transplant

BK Virus Nephropathy in Heart Transplant Recipients

2015 ◽  
Vol 65 (6) ◽  
pp. 949-955 ◽  
Author(s):  
Alin Joseph ◽  
Monika Pilichowska ◽  
Helen Boucher ◽  
Michael Kiernan ◽  
David DeNofrio ◽  
...  
Keyword(s):  
Heart Transplant ◽  
Bk Virus ◽  
Transplant Recipients ◽  
Bk Virus Nephropathy ◽  
Heart Transplant Recipients

scholarly journals Therapeutic Management of Trauma-related Acute Pancreatitis in a Heart Transplant Recipient

2019 ◽  
Vol 70 (9) ◽  
pp. 3100-3102
Author(s):  
Cosmin Banceu ◽  
Simona Gurzu ◽  
Marius Harpa ◽  
Klara Brinzaniuc ◽  
Mihaela Ispas ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Heart Transplant ◽  
Immunosuppressive Treatment ◽  
Heart Transplant Recipient ◽  
Cardiac Transplant ◽  
Life And Death ◽  
Disease Mortality ◽  
The Difference

Acute pancreatitis is a very mortal disease, mortality that increases even more in patients with cardiac transplantation. Medical-surgical management of acute pancreatitis in transplanted patients can make the difference between life and death. The aim of this paper was to highlight the severity of this pathology especially because the patient is immunosuppressed after cardiac transplant. A case of 36-year-old man, known with heart transplant, immunosuppressive treatment and chronic renal frailer, who arrived to Emergency Department, with severe abdominal pain and abdominal distention which started after a traumatic accident. Investigations revealed acute pancreatitis that needed three surgeries for acute necrotic hemorrhagic pancreatitis, acute bleeding, left subphrenic abscess and intensive care therapy. With favorable postoperative evolution, patient is discharged 60 days later He�s follow up reveled no gastrointestinal or cardiac complication with an improved quality of life.

scholarly journals Coronavirus disease 2019 (COVID-19) in the heart transplant population: a single-centre experience

2020 ◽  
Vol 58 (5) ◽  
pp. 899-906 ◽  
Author(s):  
Raphael Caraffa ◽  
Lorenzo Bagozzi ◽  
Alessandro Fiocco ◽  
Olimpia Bifulco ◽  
Matteo Nadali ◽  
...  
Keyword(s):  
Immunosuppressive Therapy ◽  
Heart Transplant ◽  
Disease Risk ◽  
Heart Transplant Recipient ◽  
Nasopharyngeal Swab ◽  
The Novel ◽  
Transplant Recipients ◽  
Single Centre Experience ◽  
Heart Transplant Recipients

Abstract OBJECTIVES Few anecdotal cases have been reported in the literature regarding heart transplant recipients and infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report our experience with 6 patients hospitalized in Northern Italy during the outbreak. METHODS Of the 396 living heart transplant recipients from 1985 to 2020 included in the study, 6 patients developed the novel 2019 coronavirus disease. Risk factors, last follow-up characteristics, onset presentation, in-hospital course of disease and blood examinations data were collected for these patients. RESULTS All patients were symptomatic and had positive results from a nasopharyngeal swab test for SARS-CoV-2. Of the 6 patients, 5 were hospitalized and 1 remained self-quarantined at home. Two patients died and 3 were discharged home. Two patients were admittted to the intensive care unit . Immunosuppressive therapy was modified with a median reduction comprising doses that were 50% cyclosporine and 50% mycophenolate. All patients received a medium-dose of corticosteroids as a bolus medication in addition to their therapy. All hospitalized patients received hydroxychloroquine; 2 patients received ritonavir/lopinavir. Broad-spectrum antibiotics for prophylaxis were administered to all. One patient had an ischaemic stroke and died of sepsis. CONCLUSIONS In the absence of any strong evidence regarding the treatment of heart transplant recipients infected with SARS-CoV-2, we faced a new challenge in managing viral infection in an immunosuppressed population. Because immunomodulation interaction with the infection seems to be crucial for developing severe forms of the disease, we managed to reduce immunosuppressive therapy by adding medium doses of corticosteroids. Despite the limited number of affected patients, this report suggests that special considerations should be given to treating coronavirus disease in the heart transplant recipient population.

Determinants of Renal Function in Pediatric Heart Transplant Recipients: Long-term Follow-up Study

2007 ◽  
Vol 26 (2) ◽  
pp. 108-113 ◽  
Author(s):  
Ritu Sachdeva ◽  
Richard T. Blaszak ◽  
Kathryn A. Ainley ◽  
James G. Parker ◽  
William R. Morrow ◽  
...  
Keyword(s):  
Renal Function ◽  
Heart Transplant ◽  
Transplant Recipients ◽  
Follow Up Study ◽  
Long Term Follow Up ◽  
Heart Transplant Recipients ◽  
Pediatric Heart Transplant

Immunosuppressive Therapy in Primary Membranous Nephropathy with Compromised Renal Function

Nephron ◽  
2021 ◽  
pp. 1-8
Author(s):  
Raja Ramachandran ◽  
Rudreshwar Prabakaran ◽  
Gnana Priya ◽  
Saurabh Nayak ◽  
Pankaj Kumar ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Dysfunction ◽  
Membranous Nephropathy ◽  
Clinical Remission ◽  
Immunosuppressive Treatment ◽  
Ckd Stage ◽  
Stage Renal Disease ◽  
End Stage ◽  
Prospective Longitudinal

<b><i>Introduction:</i></b> Renal dysfunction at presentation is uncommon in primary membranous nephropathy (PMN). The data on the outcome of PMN patients with renal dysfunction at outset are scarce. The objective of the current study was to report the clinical outcomes of PMN patients with renal dysfunction. <b><i>Material and Methods:</i></b> This prospective longitudinal observational study included PMN patients (both incident and treatment resistant) with an estimated glomerular filtration rate of &#x3c;60 mL/min/1.73 m<sup>2</sup>. Immunosuppressive treatment was as per the unit’s protocol. Patients were evaluated for proteinuria, creatinine, and serum albumin at monthly intervals for 6 months, then quarterly for a year, and then biannually. Both serum and tissue anti-PLA2R were performed at baseline. Outcome: Percentage of patients achieving clinical remission. <b><i>Results:</i></b> Sixty-four adults met study criteria and were analysed. The median (IQR) age of the patients was 48 (40, 56) years. PMN was PLA2R related in 52 (81.3%) patients. Twenty-eight (43.8%) and 30 (46.9%) patients were in remission at 12 months and at the end of the study [median (IQR) follow up: 24 months (12, 35)], respectively. Eight (12.5%) had progressed to end-stage renal disease at the last follow-up. Median (IQR) baseline anti-PLA2R titre was 150.1 RU/mL (38.5, 308). Nineteen (61.3%) and 18 (58.1%) patients with &#x3e;90% reduction in anti-PLA2R titres at 12 months were in clinical remission at 12 months and at the end of the follow-up, respectively. Both cyclical cyclophosphamide/steroids (cCYC/GC) and rituximab were equally effective in inducing remission, but rituximab had a favourable adverse event profile compared to cCYC/GC. <b><i>Conclusion:</i></b> To conclude, both cCYC/GC and rituximab are equally effective in inducing remission of nephrotic state with compromised renal function due to PMN. Immunosuppression induces remission in up to 50% PMN patients with CKD-stage 3–4.

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